Addicted and Mentally Ill

Stories of Courage, Hope, and Empowerment

Bruce Carruth, Carol Bucciarelli

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781317825432
• Topic: Medicine
• Subtopic: Anesthesiology & Pain Management

Reconnect with dually diagnosed individuals using stories they can identify with!

Addicted and Mentally Ill: Stories of Courage, Hope, and Empowerment is a powerful tool to recommend to your clients who are dually diagnosed. This book presents vignettes about people with mental illness and addiction whose situations are representative of what goes on in a dual-diagnosis in-patient setting. This nonclinical, easy-to-read resource will give you, your patients, and their family members unique insight on dual diagnosis and how co-occurring mental illness and addiction can be treated with the minimum amount of blame, shame, or poor decision-making.

Addicted and Mentally Ill focuses on the most significant issues surrounding these individuals, such as:

• dual diagnosis and the family systemhow family can help or hinder treatment
• the reasons why dually diagnosed clients resist treatment
• the fear of losing self-identity in treatment
• the misunderstandings about dual diagnosisfrom the perspectives of the client, family members, and professionals in medicine and social work
• the role of hope, empowerment, and spirituality in recovery in dual diagnosis
• what the patient/client and family members can do to improve treatment options

Addicted and Mentally Ill is unique for its storytelling format, consisting of brief tales and short explanations you can recommend to clients and families with limited clinical knowledge or time. This innovative tool answers many of the questions that dually diagnosed individuals may have and helps them learn of the issues surrounding their illness as well as their addiction. For those professionals who provide direct counseling to these clients or patients, this book offers an interesting and nonthreatening way to help them learn about treatment options.

The stories in Addicted and Mentally Ill confront the life problems specific to dually diagnosed individuals, including:

• alcohol, drugs, and self-medication
• the difficulties of building trust in group therapy settings
• psychotropic medications
• illnesses such as bipolar disorder, schizophrenia, depression, and personality disorders
• suicide

Chapter 1

Dual Diagnosis and the Family System

What is home to you? Is it a place where you can be yourself? Or is it a place where you have to “toe the line,” always meeting the expectations of others? For dually diagnosed people, home often turns out to be a place where they are continually observed. Are they using drugs? Are they complying with their medication regimen? Is their behavior erratic?

People with mental illness and addiction, even when remaining sober, may see certain manifestations of their mental illness as a big part of who they are. People who suffer from rapid mood swings may feel more creative when they are in a “high” mood, whereas their families may experience this type of mood as grandiosity or the behavior as “overexcited” and lacking in judgment. What a family member calls “those voices in your head” may seem, to a dually diagnosed person, his or her own special kind of reality. At times, such a person may have periodic needs to isolate, or fears that appear to make sense to no one but himself or herself. Though prescribed medication can alleviate or reduce mental illness symptoms, individuals may refuse or cut down on medications that make them feel unlike themselves. At times, recovering people may feel very much like themselves, but, to others, they may appear unstable.

From the family’s point of view (whether family consists of the dually diagnosed person’s parents, children, or significant others), living with someone whose behavior is not always consistent is both frightening and unnerving. Families may become oversensitive or even defensive about behaviors that are not symptoms of mental illness simply because they are so fearful of relapse.

Answers to the question of “who takes care of whom” may be much easier to find for the person who is addicted but does not have a mental illness. Tough love has long been touted as the way to help addicts “find their bottom.” Even in cases such as this, however, a family may find it difficult to know the point at which the addict’s judgment is too impaired for the individual to be able to make proper decisions about caring for himself or herself.

How much more difficult are these issues, then, for families of dually diagnosed people? How can a family use tough love on someone who is actively using cocaine and also delusional? Families often want to believe that their family members can control their addiction even if they cannot manage their mental illness all of the time.

It is important for people with mental illness and addiction as well as their families to remember that both addiction and mental illness are diseases. Most important, they are diseases that need to be treated together, not separately. Unfortunately, in many states today, these treatments are not always offered together. Too often, addicted mentally ill people find themselves in a confrontive addiction group that may cause them to feel unsafe, and thus drop the group. Often, even in twelve-step meetings, mentally ill addicts may feel they do not fit in, particularly if they are not completely stable on their medications.

During the time I treated dually diagnosed people in an inpatient setting, I witnessed many heartbreaking scenarios. I saw mothers who were unable to retain custody of their children because of continued psychiatric hospitalizations. Once out of the hospital, however, these same mothers risked losing their children again because they would resume using drugs. The stressors of motherhood, financial problems, and the social stigma faced by someone who “cannot get it together” all combine eventually to cause such mothers to lose their children for good.

Caught in such a scenario, a mother may feel she has no real reason to “get straight.” She may very well have come from a dysfunctional family herself in which one or both parents were addicts or mentally ill. Having children may have represented, to her, the first time she felt loved and in control of her life. Losing these children (and being told it is her fault) can often cancel any hope she holds for the future.

Another scenario that I have witnessed is the individual who enters treatment so that he or she may return to live with the family. The family, however, burned out after years of struggling to assist the individual in maintaining stability, may not allow the person back in the family home, no matter how well he or she does in treatment. Family members may be convinced that, if the individual had stayed away from drugs (or alcohol), none of this would have happened; thus, they may conclude that it is no longer their role to provide support for something the person brought on himself or herself.

Although it is true that the abuse of drugs and alcohol is not conducive to stability in someone who is mentally ill, addiction is not usually the cause of the mental illness. However, sometimes individuals who are mentally ill and addicted may continue to use drugs or alcohol within the structure of their families so that they may appear more “normal” to those with whom they live. This drug use may or may not be in conjunction with taking prescribed psychotropic medications. Individuals may repeat treatment episodes time and time again with the primary desire to remain in the family home. In the family home, however, their behaviors, even when they are sober and stable on medication, may still prove frustrating to their families, and, therefore, they may retain the sense that nothing they do is enough.

Another common scenario is when husbands or wives come into treatment and openly admit that they are there because their spouses said they would leave them if they did not get help. Unfortunately, summoning up the motivation to do the hard work of recovery can be difficult when everything depends on whether someone else will stay or leave. Some of my patients struggled to get well and maintained months, even years, of sobriety and stability and still their mates left. Sometimes, too, when people become sober and stable they may realize the relationships they set out to save are unhealthy, and they become the ones to end the relationships. Although people may seem to enter treatment for all the wrong reasons, many times the end result can still be health. As a counselor, I try not to judge a person’s motive for getting treatment.

What is the answer, then, to our initial question about caretaking? As much as possible, I have tried to teach the people with whom I work that their most important and true home is inside themselves. People in the throes of active addiction often become spiritually bankrupt; they no longer have any sense of self-worth, and they become accustomed to searching outside themselves for meaning. In our twelve-step program, we teach that individuals who are members of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) are willing to become family to those seeking to address their addiction. Sponsors (people who have been sober and offer to guide others through sobriety) can be mentors and family as well. A home group (meetings held on a weekly basis) can be a touchstone for people who want to know themselves and measure their progress. Most important, twelve-step programs teach that one must come in contact with a higher power to help the individual as he or she tries to achieve quality of life.

I do not mean to imply here that people should merely pray to rid themselves of mental illness and addiction. What I do mean is that building a support system outside the family of origin is essential if people are to be successful in recovery. People who are not in recovery from addiction often have difficulty understanding the rigors of staying sober.

I often encounter people with mental illness and addiction who do not feel comfortable in traditional AA or NA meetings. Common today are twelve-step programs with meeting attendees who may have to be on psychotropic medications and this is not viewed as compromising their sobriety. Still, those who suffer from paranoia, severe mood swings, or delusions are generally uncomfortable in the twelve-step group environment. In our New Jersey treatment program we hold Double Trouble meetings that cater specifically to people who are dually diagnosed.

Specific mental illness support groups can be accessed online through New Jersey’s (or any other state’s) Self Help Group Clearinghouse. Some examples in New Jersey are GROW (for prevention and recovery from depression, anxiety, and other mental health problems), the Depressive and Manic Depressive Association (DMDA), the Depression/Anxiety Support Group, Choices (support for depression), Parents of Bi-Polar Children, and many others. Unfortunately, it is often difficult for dually diagnosed people to address addiction issues comprehensively within these groups because they may not have the opportunity of working with twelve-step sponsors who are dually diagnosed even though they have a good understanding of mental health issues.

WHO TAKES CARE OF WHOM?

As much as possible, individuals with mental illness and addiction need to find ways to care for themselves, perhaps better than ever before in their lives. They need to find faith that a higher power is there for them, whether that be the group, a sponsor, or their notion of God.

What, then, is the role of the family? Just as we teach dually diagnosed people the need for acceptance of themselves and their illness if they are to achieve full recovery, families, too, must learn to accept these people as they are, people with whom they may or may not choose to live. They may do this through attending groups such as Al-Anon or the National Alliance for the Mentally 111 (NAMI). They may do this with the help of their church or a counselor. Certainly, they may choose not to do this at all. One basic truth, however, is that most people, if they are to have quality of life, need to experience love and acceptance from important people in their lives. Families who become educated about the mental illness of a family member as well as about the dynamics of addiction stand a better chance of accepting the recovering dually diagnosed person than the families who choose to remain in the dark.

Guilt and shame often can be deterrents to change for dually diagnosed individuals and their families. Parents are often afraid they may have done something to cause their child’s illness. They may fear that, somehow, they are not doing the right things to help their child get or stay well. These beliefs may translate into self-consciousness about their child’s behaviors and lack of acceptance of the possibility of relapses, regardless of how hard everyone works.

Rather than focusing on who is to blame for what, families and individuals with mental illness and addiction would do best to build their own separate support systems and then work to accept one another as they are. Dually diagnosed individuals should learn to admit how some of their behaviors can be frustrating for their families. They could even choose, finally, to live separately from their families so that they can enjoy short periods of quality time with their families when they are doing well. Group homes, halfway houses, and many other kinds of supervised-living situations often are the answer to this quandary.

Once the family and the dually diagnosed individual become educated about the nature of the disease of addiction and the person’s specific mental illness, they may begin accepting what some reasonable goals for living might be. Maybe the individual will be able to work part- or full-time, and maybe not. Maybe the person will be able to remain out of the hospital for long periods of time, even for good, and maybe not. If both the dually diagnosed person and the family can decide to focus on the progress the individual is able to make in conjunction with his or her capabilities and limitations, frustrations may begin to diminish. It is important for the family to know what progress means for this person and to acknowledge it. It is important for the person who is dually diagnosed to do his or her best to try to move forward and be compliant with treatment, by working with a support system consisting of twelve-step meetings and a sponsor; doctors, counselors, and perhaps an outpatient program; and a supervised-living situation.

Such support systems have, as a common goal, the regular acknowledgment of an individual’s strengths, encouraging the person to take part actively in decisions concerning his or her life. These support systems and the family can assist the dually diagnosed person by providing empowerment. Individuals who manage their own lives to the fullest extent are able to begin to feel that they have substance after all, and that all the powerlessness they have felt can be managed through seeking daily support.

In the vignette that follows, you will meet Beverly, whose story exemplifies the difficulties families and dually diagnosed individuals experience when asking, “Who takes care of whom?” Beverly’s experience depicts the cycle of guilt, shame, and punishment that can exist from generation to generation when the need for acceptance and empowerment of the individual is not recognized.

Beverly’s Story

The last time I remember seeing Beverly was during her fourth stay in our MICA unit. An African-American woman in her midforties, Beverly was the mother of three grown children, one of whom housed and cared for Beverly when Beverly was not smoking crack. Primarily, Beverly had a habit of coming into our rehab facility to satisfy her eldest daughter whenever she, once again, told Beverly that she would have to clean up her act if she did not want to be homeless. Beverly had been diagnosed with paranoid schizophrenia in her early twenties. She was unable to remember the number of psychiatric hospitalizations she’d had, but she did know that some of them had been for as long as eighteen months, an unusual length of time in this day of deinstitutionalization. Beverly’s baseline (or usual mode of functioning), even at her best, was not good. Even when Beverly was compliant on her medication and not using drugs, she was paranoid, constantly heard voices, and had difficulty remaining in touch with reality.

Over the years I had become familiar with Beverly’s story in a hit-or-miss fashion. She’d been assigned to my caseload each time, so I’d gradually been able to build some trust with her and to get a sense of what her life had been and was like.

Although Beverly’s difficulty with trust was clearly due to her schizophrenia, I could not help but feel that the traumas she had experienced as a child were also a big part of her illness. Beverly’s own mother had been diagnosed with schizophrenia shortly after Beverly’s birth. Beverly, when she would talk about it, remembered a toddlerhood rife with warnings and suspicion. Beverly and her two younger brothers spent days at a time locked with their mother in her small, cluttered apartment. Drawn shades and furniture shoved against the door were always present in Beverly’s memories. She told me those memories were a strong trigger for her to smoke crack.

I was reminded of how many of my patients tried so hard to re-create their childhood because it was familiar. Abuse can be familiar and sometimes even, in an odd way, reassuring. As a child grows, systems of reward and/or punishment occur and reoccur and finally become entrenched. The child comes to expect abuse if it is a pattern over a long enough period of time. Abuse can provide a kind of closure for a person who is accustomed to it and may have grown up feeling he or she deserved it. Later in life, the abused person may even gravitate to a significant other who will repeat the familiar abuse pattern.

Beverly had grown up afraid and cautious. She’d been in and out of foster homes because of her mother’s hospitalizations. Neither she nor her two siblings had any idea who their father was. They never knew when their mother might come out of the hospital and reclaim them for a time, only to wind up being reimmersed in her world of horrors.

Beverly had her first baby at the age of fifteen. She named the child Angela because the child had seemed like an angel to her, someone who would love Beverly as she had not experienced love before.

As with so many of my clients, Beverly was more willing to get clean and sober for someone else than she was for herself. Maybe that’s why her longest clean time after each of her previous stays had been no longer than six months.

I’d hoped that Beverly, as an inpatient, would find support in the on-site Double Trouble meetings we held twice weekly. It was clear, observing her in her first meeting, that being surrounded by a roomful of people she did not know was frightening for her. Halfway through the meeting, she asked me if she could go to her room.

Later, she admitted that going to any kind of twelve-step meeting was very difficult for her. As part of her outpatient program she had attended numerous meetings in the past, and Beverly confided that she always felt as if she did not belong there. She explained that she often felt the people were looking at her or talking about her, and she threatened to leave the outpatient program if she was forced to go to meetings.

For Beverly to learn about twelve-step principles and build a support system, I believed that she would most likely need constant repetition of what to do and what not to do in order to stay sober. Further, she would need small groups of people who knew her well and whom she trusted to be there for her.

In one of our dialogues I asked Beverly why she smoked crack when it clearly angered Angela and also made Beverly more paranoid. Beverly spoke of the sadness that would come over her which only crack seemed to take away. She told of how her children treated her as if she were the child—not letting her have any money; talking about her when she was in the room; accusing her of using crack when she was not. She spoke of how angry they got when she would finally resort to prostitution to get money for herself.

I was hearing the same self-defeating story I had heard with so many other addicts, particularly the most disenfranchised. Prostitution often became as much of an addiction as the drug habit. It was a way to make quick money and, sometimes, a way, no matter how unsatisfactory or rudimentary, of connecting. Beverly, who had the concrete mode of thinking that sometimes comes with schizophr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Acknowledgments
• Chapter 1. Dual Diagnosis and the Family System
• Chapter 2. Reasons for Resisting Treatment
• Chapter 3. Misunderstandings About Dual Diagnosis
• Chapter 4. The Role of Hope, Empowerment, and Spirituality in Recovery for the Dually Diagnosed Client
• Chapter 5. What the Consumer and the Family of the Consumer Can Do Today to Improve Treatment Options
• Suggested Readings
• Index